Provider Demographics
NPI:1366027708
Name:AVILA, MIGUEL E (ARPN)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:E
Last Name:AVILA
Suffix:
Gender:M
Credentials:ARPN
Other - Prefix:MR
Other - First Name:MIGUEL
Other - Middle Name:E
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1560 W 46TH ST APT 212
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7132
Mailing Address - Country:US
Mailing Address - Phone:305-778-0668
Mailing Address - Fax:
Practice Address - Street 1:5040 NW 7TH ST STE 822
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3435
Practice Address - Country:US
Practice Address - Phone:305-260-6615
Practice Address - Fax:305-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty